再次心脏瓣膜手术后出血的防治

Prevention of Postoperative Bleeding after Redo Cardiac Valve Operation

回顾性分析了６４例再次心脏瓣膜手术中应用大剂量抑肽酶（５～７万ＫＩＵ／ｋｇ）和（或）凝血酶原复合物（４００Ｕ）减少术后出血和输血的作用。结果显示，用药组（抑肽酶组、凝血酶原复合物组和二者合用组）与对照组相比，术后１８ｈ内的出血量和输血量分别显著减少３５％～５４％和３３％～４２％（Ｐ＜０．０５～０．０１）。无严重出血（胸液＜１０００ｍｌ／１８ｈ）者较有严重出血者（≥１０００ｍｌ／１８ｈ）术后早期多脏器功能衰竭发生率显著降低（Ｐ＜０．０５），术后早期死亡率也较低。大剂量抑肽酶的作用与凝血酶原复合物的作用相同，单用与二者合用的效果相似（Ｐ＞０．０５），抑肽酶副作用较凝血酶原复合物为小。结论：在再次心脏瓣膜手术中应常规应用大剂量抑肽酶。

The effects of high-dose aprotinin(50,000～70,000 KIU/kg) and/or human lyophilized prothrombin complex(400μ)used during the operation to reduce the amount of postoperative bleeding and blood transfusion were retrospectively analyzed in 64 patients with redo cardiac valve operations.The results showed that the volume of blood loss and blood transfusion required were significantly reduced about 35%～54%and 33%～42%respectively in the drugtreated(aprotinin,prothrombin complex or in combinations) groups as compared with the control group within l8 hours after operation (P<0.05～0.01).The morbidity of multiple organ failure during early postoperative period was 42.86%in cases with severe postoperative bleeding(1ml/kg·h-1 for 18h) and 8.77%in those without (P<0.05).The early postoperative mortality was 28.57%and 3.51%in cases with and without severe postoperative bleeding respectively, but the difference didn't reach statistical significance(P>0.05).The effect of high-dose aprotinin was similar to that of prothrombin complex and approximate to that of thier combined use,and its side-effects were lower than those of prothromin complex.So we consider that high-dose aprotinin should be used as a routine in the redo cardiac valve operations,especially in double valve replaeement.